答曰。夫胃为受纳之司。大肠为传道之府燥屎岂有在胃中哉
。故经言谷消水去形亡也以是知在大肠而不在胃中明矣。
胃实者非有物也。地道塞而不通
也。故使胃实。是以腹如仰瓦。注曰。难经云。胃上口为贲门。胃下口为幽门。幽门接小肠上
口。小肠下口。即大肠上口也。大小二肠相会为阑门。水渗泄入于膀胱渣滓入于
大肠。结于广肠。广肠者地道也。地道不通土壅塞也则火逆上行至胃。名曰胃实。所以言阳
明当下者言上下阳明经不退也言胃中有燥屎五六枚者。非在胃中也。通言阳明也。言胃是连
及大肠也。以其胃为足经。故从下而言之也。从下而言。是在大肠也。若胃中实有燥屎。
则小肠乃传导之府。非受盛之府也。启玄子云
。小肠承奉。胃司受盛。糟粕受已复化传入大肠。是知燥屎在大肠之下。即非胃中有也。
答曰。阳入于阴者可下。非入太阴少阴厥阴之三阴也。乃入三阳也。三阳者。非太阳
少阳阳明之三阳也。乃胃与大小二肠之三阳也。三阳皆为府以其受盛水谷。传导有形。故曰
入于阴也。仲景云。已入府者可下。此之谓也。
黄帝问伤寒或愈或死。其死皆以六七日其愈十日以上者何。岐伯对。以热虽甚不死两感
者死
。帝问其状。岐伯云。一日太阳。二日阳明。三日少阳。继之三阳经络皆受病。而未入于藏
者。可汗而已。此藏物之藏。非五脏之脏也。若三阳经入于藏物之藏。是可泄也。可泄一句
。于此不言便言四日太阴。五日少阴。六日厥阴。于此却不言可泄。但言三阴三阳五脏六腑
皆受病。荣卫不行。五脏不通。则死。此一节。是言两感也。故下文却言两感于寒者。七日巨
阳衰。至十二日六经尽衰。大气皆去。其病已矣。是通说上文。六日所受之病也。以此知前
文四日太阴五日少阴。六日厥阴。皆在经络。故十二日
愈也。岂可便以太阴少阴厥阴为可泄乎。帝问治。岐伯对。以治之各通其藏脉日衰已矣。是
通说上文。六日所受之病。并十二日衰已之意尽矣。终复言其未满三日可汗而已。又言其满
日可泄而已。一句只是重前文三阳受病。未入于藏者可汗。其满三日已入于藏物之藏者可
。后三阴经。岐伯虽不言可汗可泄。止是在经者便可汗在藏物之藏者便可下也。何必穿凿无
已。以前三日为三阳后三日为三阴耶。若认藏字为五脏之脏则前后颠倒不通。若认藏字作藏
之藏。则前后辞理皆顺矣。故仲景曰。已入于府者可下。新校正云府字当作藏字。太素亦云作府。何疑之有。
仲景太阳阳明（大承气）。少阳阳明（小承气）。正阳阳明（调胃承气）。是三阳已入于藏者泄之
也。太阴（桂枝汤。）少阴（麻黄附子细辛汤）。厥阴（当归四逆汤）。是三阴未入于藏者。汗之也。
大小（调胃三承气汤）必须脉浮头痛。恶风恶寒表证悉罢。而反发热。恶热谵言妄语不大
便者则当用之。凡用下药。不论大小。若不渴者。知不在有形也。则不当下。若渴者。则知
缠有形也。缠有形是为在里。在里则当下。（大承气汤）主之。
答：胃是受纳食物的器官。大肠是传导糟粕的腑，燥屎怎么会在胃中呢？所以《内经》说：“谷物消化、水液代谢后，形体（指糟粕）就形成了。”由此可知，燥屎在大肠而不在胃中，这是很明显的。
所谓的“胃实”，并不是指胃中有实物积滞，而是指地气（肠道之气）阻塞不通。正因为这种阻塞导致胃气不降，出现类似“胃实”的症状，所以腹部胀满像倒扣的瓦盆一样。注释说：《难经》记载，胃的上口叫贲门，胃的下口叫幽门。幽门连接小肠的上口，小肠的下口就是大肠的上口。大小肠相会的地方叫阑门。水液渗入膀胱排泄，渣滓进入大肠，积聚在广肠。广肠就是地道。如果地道不通，土气壅塞，火气就会逆乱上行至胃，这就叫做“胃实”。所以说阳明病应当用下法，是指上下阳明经的气机不退；说胃中有五六枚燥屎，其实并不在胃中，这是泛指阳明经而言。说“胃”，是连带提及大肠。因为胃属于足经，所以从下部来说明。从下部来说，燥屎是在大肠里。如果胃中真的实有燥屎，那么小肠就成了传导之府，而不是受盛之府了。启玄子（王冰）说：“小肠承接并奉送食物，胃负责受纳和盛装。糟粕被接受后，再转化传入大肠。”由此可知，燥屎位于大肠之下，并非在胃中。
答：阳热邪气入于阴分，就可以使用下法。这里说的“阴”，不是指太阴、少阴、厥阴这三阴经，而是指三阳中的阴分。这里的“三阳”，不是指太阳、少阳、阳明这三阳经，而是指胃与大小肠这三个属阳的腑。这三个腑都作为府，因为它们受纳和盛装水谷，传导有形之物，所以称为“入于阴”。张仲景说：“病邪已入腑者，可以使用下法。”说的就是这个意思。
黄帝问：伤寒病有的痊愈，有的死亡，死亡的多发生在六七天，痊愈的多在十天以上，这是什么原因？岐伯回答：虽然热势很重，但只要不是两感寒邪，就不会死；如果是两感寒邪，就会死。黄帝询问具体症状，岐伯说：第一天太阳经受病，第二天阳明经受病，第三天少阳经受病。接着三阳经络都受了病，但病邪尚未进入“藏物之藏”（指六腑），可以通过发汗治愈。这里的“藏”，指的是容纳物质的腑，而不是五脏之脏。如果三阳经的病邪进入了“藏物之藏”，就可以使用泄下法。关于“可泄”这一点，文中没有紧接着说第四天太阴、第五天少阴、第六天厥阴的情况，而是直接说三阴三阳、五脏六腑都受了病，营卫运行停滞，五脏气机不通，就会死亡。这一段讲的是两感证。所以下文又说两感于寒邪的人，第七天巨阳（太阳）衰败，直到第十二天六经之气全部衰败，大气（正气）离去，病也就好了。这是对上文所说的六天所受病情的通论。由此可知，前文提到的第四天太阴、第五天少阴、第六天厥阴，病邪都在经络中，所以第十二天能痊愈。怎么能直接把太阴、少阴、厥阴当作可以用泄下法的依据呢？黄帝问治疗方法，岐伯回答：治疗时要分别疏通各脏腑的经脉，病气自然会衰退。这也是对上文六天所受病情以及十二天病气衰退意思的通论。最后又说：未满三天，可以通过发汗治愈；已满三天，可以通过泄下治愈。这句话只是重复前文：三阳受病，未入于藏物之藏的，可以发汗；已满三天，已入于藏物之藏的，可以泄下。对于后三阴经，岐伯虽然没有明说可汗可泄，但意思是：病在经的就可以发汗，病在藏物之藏的就可以攻下。何必穿凿附会，无休无止地把前三天定为三阳、后三天定为三阴呢？如果把“藏”字理解为五脏之脏，那么前后文意就颠倒不通了；如果把“藏”字理解为藏物之藏（即六腑），那么前后的文理就都顺通了。所以张仲景说：“病邪已入腑者，可以使用下法。”新校正说“府”字应当作“藏”字，《太素》也说是作“府”，这有什么可疑的呢？
张仲景所说的太阳阳明（大承气汤）、少阳阳明（小承气汤）、正阳阳明（调胃承气汤），是三阳病已入于藏物之藏，采用泄下的方法。太阴（桂枝汤）、少阴（麻黄附子细辛汤）、厥阴（当归四逆汤），是三阴病未入于藏物之藏，采用发汗的方法。大小承气汤及调胃承气汤等，必须见到脉浮、头痛、恶风、恶寒等表证完全消失，反而发热、怕热、胡言乱语、神志不清、不大便的情况，才应当使用。凡是使用下药，不论是大承气还是小承气，如果不口渴，就知道病邪不在有形之质（肠胃燥屎），就不应当用下法。如果口渴，就知道病邪缠结在有形之质上。病邪缠结在有形之质，说明病位在里，在里就应该用下法。（大承气汤）主治。
Answer: The Stomach is the organ responsible for receiving and accepting food. The Large Intestine is the fu-organ responsible for transmission; how can dry feces be in the Stomach? Therefore, the *Classic* states: "When grain is digested and water passes away, the form (referring to waste) is created." From this, we know that dry feces are in the Large Intestine and not in the Stomach, which is clear.
What is called "Stomach Excess" (Wei Shi) does not mean there is solid matter accumulated in the Stomach, but rather that the Qi of the Earth (intestinal Qi) is blocked and unobstructed. Because of this blockage causing Stomach Qi to fail to descend, symptoms resembling "Stomach Excess" occur, resulting in abdominal distension like an inverted tile. The commentary notes: The *Nan Jing* records that the upper opening of the Stomach is the Jian Gate (Benmen), and the lower opening is the You Gate (Yumen). The Yumen connects to the upper opening of the Small Intestine, and the lower opening of the Small Intestine is the upper opening of the Large Intestine. Where the Small and Large Intestines meet is called the Lan Gate. Water seeps into the Bladder for excretion, while dregs enter the Large Intestine and accumulate in the Guang Chang (Hengchang/Rectum). The Guang Chang is the "Earthly Path" (Di Dao). If the Earthly Path is unobstructed, Earth Qi becomes stagnant, and Fire Qi rebels upward to the Stomach; this is named "Stomach Excess." Thus, when it is said that Yangming disease should be treated with purgation, it refers to the failure of the Upper and Lower Yangming meridians' Qi to retreat. When it says there are five or six pieces of dry feces in the Stomach, they are actually not in the Stomach; this is a general reference to the Yangming channel. Mentioning the "Stomach" implicates the Large Intestine. Because the Stomach belongs to the Foot Meridians, it is described from the lower aspect. Speaking from the lower aspect, the dry feces are in the Large Intestine. If there were truly dry feces solidly in the Stomach, then the Small Intestine would become a transmitting fu-organ rather than a receiving and containing one. Qixuanzi (Wang Bing) said: "The Small Intestine receives and conveys; the Stomach manages reception and containment. After dregs are received, they are transformed and transmitted to the Large Intestine." From this, we know that dry feces are located below the Large Intestine, not in the Stomach.
Answer: When Yang pathogenic factors enter Yin, purgation may be used. Here, "Yin" does not refer to the Three Yin meridians (Taiyin, Shaoyin, Jueyin), but to the Yin aspect within the Three Yang. These "Three Yang" do not refer to the Three Yang meridians (Taiyang, Shaoyang, Yangming), but to the three yang fu-organs: the Stomach, Small Intestine, and Large Intestine. These three fu-organs are all considered fu because they receive and contain water and grain, and transmit有形 (tangible) substances; thus, they are referred to as "entering Yin." Zhang Zhongjing said: "When the pathogen has entered the fu-organ, purgation may be employed." This is what is meant.
Yellow Emperor asked: In cold damage diseases, some recover and some die; death usually occurs on the sixth or seventh day, while recovery often happens after ten days. Why? Qibo replied: Even if the heat is severe, death will not occur unless it is a case of "double exposure" (Liang Gan); if it is double exposure, death will occur. The Emperor asked about the specific manifestations. Qibo said: On the first day, the Taiyang meridian is affected; on the second day, the Yangming meridian; on the third day, the Shaoyang meridian. Subsequently, the Three Yang meridians are all diseased, but if the pathogen has not yet entered the "Zang of storing substances" (referring to the Six Fu-organs), it can be cured by sweating. This "Zang" refers to the organ storing substances, not the Five Zang organs. If the pathogens of the Three Yang meridians enter the "Zang of storing substances," purgation (draining) can be used. Regarding the phrase "can be drained," the text does not immediately mention the fourth day (Taiyin), fifth day (Shaoyin), and sixth day (Jueyin), but instead states that when the Three Yin and Three Yang, Five Zang and Six Fu-organs are all diseased, and Ying and Wei circulation stops, and the Five Zang qi mechanisms are blocked, death ensues. This section discusses double exposure. Hence, the following text states that for those double-exposed to cold, on the seventh day, the Ju Yang (Taiyang) declines, until the twelfth day when the Qi of all six meridians is exhausted, the Great Qi departs, and the illness ends. This is a general explanation of the pathology acquired over the previous six days. From this, we know that the Taiyin on the fourth day, Shaoyin on the fifth day, and Jueyin on the sixth day mentioned earlier involve pathogens remaining in the meridians; therefore, recovery occurs on the twelfth day. How can one simply consider Taiyin, Shaoyin, and Jueyin as indications for purgation? The Emperor asked about treatment. Qibo replied: Treatment involves regulating the meridians of each respective zang-fu, and the pathogenic qi will decline. This also generally explains the meaning of the pathology acquired over six days and its decline by the twelfth day. Finally, it reiterates: If less than three days have passed, it can be cured by sweating; if three days or more have passed, it can be cured by draining. This sentence merely repeats the preceding text: For Three Yang diseases not yet entering the "Zang of storing substances," sweating is appropriate; for those fully three days old and having entered the "Zang of storing substances," draining is appropriate. For the latter Three Yin meridians, although Qibo did not explicitly state whether sweating or draining is applicable, the implication is: if the pathogen is in the meridians, sweating is suitable; if it is in the "Zang of storing substances," draining is suitable. Why resort to forced interpretations, endlessly dividing the first three days as Three Yang and the last three days as Three Yin? If the character "Zang" is interpreted as the Five Zang organs, the preceding and following texts become contradictory and illogical. If "Zang" is interpreted as the "Zang of storing substances" (i.e., the Six Fu-organs), the logic flows smoothly throughout. Therefore, Zhang Zhongjing said: "When the pathogen has entered the fu-organ, purgation may be employed." The New Correction notes that the character "Fu" should be read as "Zang," and the *Tai Su* also reads it as "Fu." What is there to doubt?
Zhang Zhongjing's references to Taiyang-Yangming (Da Cheng Qi Tang), Shaoyang-Yangming (Xiao Cheng Qi Tang), and Zhengyang-Yangming (Tiao Wei Cheng Qi Tang) indicate that when Three Yang diseases have entered the "Zang of storing substances," purgation is used. Taiyin (Gui Zhi Tang), Shaoyin (Ma Huang Fu Zi Xi Xin Tang), and Jueyin (Dang Gui Si Ni Tang) indicate that when Three Yin diseases have not yet entered the "Zang of storing substances," sweating is used. Da Cheng Qi Tang, Xiao Cheng Qi Tang, and Tiao Wei Cheng Qi Tang must be used only when the pulse is floating, accompanied by headache, aversion to wind and cold, where all exterior signs have resolved, yet fever persists, aversion to heat, delirious speech, and constipation are present. Whenever purgatives are used, regardless of strength, if there is no thirst, it indicates the pathogen is not in tangible forms (such as dry feces), and purgation is contraindicated. If there is thirst, it indicates the pathogen is entangled in tangible forms. Entanglement in tangible forms signifies an interior location; interior locations require purgation. (Da Cheng Qi Tang) is indicated.